Empiric Data Research Articles

A numerical analysis of the short open load calibration robustness for capacitance measurements in scanning microwave microscopy

Abstract Numerous experimental parameters affect the accuracy of impedance measurements in scanning microwave microscopy (SMM). Investigating their effects on the measured values is particularly challenging. Here, we present the development of a fully-numerical finite element method-based simulation of the actual SMM measurements. We demonstrate the application of a self-calibration procedure for the simulated SMM measurements with a maximal deviation of ±0.8% relative to reference capacitances determined via an electrostatic finite element model. Furthermore, we demonstrate the possibility of assessing water meniscus-induced effects on the simulated SMM measurements. Typically, water meniscus impacts the calibration by a 0.4% relative deviation, in accordance with previously reported empiric data. Our findings are expected to promote access to a deeper understanding of nanoscale capacitance measurements in SMM.

External validation and calibration of risk equations for prediction of diabetic kidney diseases among patients with type 2 diabetes in Taiwan

BackgroundMost existing risk equations for predicting/stratifying individual diabetic kidney disease (DKD) risks were developed using relatively dated data from selective and homogeneous trial populations comprising predominately Caucasian type 2 diabetes (T2D) patients. We seek to adapt risk equations for prediction of DKD progression (microalbuminuria, macroalbuminuria, and renal failure) using empiric data from a real-world population with T2D in Taiwan.MethodsRisk equations from three well-known simulation models: UKPDS-OM2, RECODe, and CHIME models, were adapted. Discrimination and calibration were determined using the area under the receiver operating characteristic curve (AUROC), a calibration plot (slope and intercept), and the Greenwood-Nam-D’Agostino (GND) test. Recalibration was performed for unsatisfactory calibration (p-value of GND test < 0.05) by adjusting the baseline hazards of risk equations to address risk variations among patients.ResultsThe RECODe equations for microalbuminuria and macroalbuminuria showed moderate discrimination (AUROC: 0.62 and 0.76) but underestimated the event risks (calibration slope > 1). The CHIME equation had the best discrimination for renal failure (AUROCs from CHIME, UKPDS-OM2 and RECODe: 0.77, 0.60 and 0.64, respectively). All three equations overestimated renal failure risk (calibration slope < 1). After rigorous updating, the calibration slope/intercept of the recalibrated RECODe for predicting microalbuminuria (0.87/0.0459) and macroalbuminuria (1.10/0.0004) risks as well as the recalibrated CHIME equation for predicting renal failure risk (0.95/-0.0014) were improved.ConclusionsRisk equations for prediction of DKD progression in real-world Taiwanese T2D patients were established, which can be incorporated into a multi-state simulation model to project and differentiate individual DKD risks for supporting timely interventions and health economic research.

Posttreatment surveillance intensity and overall survival in prostate cancer survivors (AFT-30).

Posttreatment surveillance affects millions of cancer survivors, but empiric data to guide clinical practice are lacking. This study assessed whether the intensity of surveillance testing after radical prostatectomy or radiation therapy for localized prostate cancer is associated with overall survival. Men diagnosed with localized prostate cancer between 2005 and 2010 who underwent radical prostatectomy or radiation therapy at a Commission on Cancer-accredited facility were randomly sampled. Primary data collected from 10147 patients sampled across 1007 facilities were linked with existing data from the National Cancer Database. Analysis examined whether intensity of surveillance measured as the number of prostate-specific antigen (PSA) tests in the first year after primary treatment (categorized as 0-1 [low intensity], 2 [medium], or ≥3 [high intensity] PSA tests) was associated with overall survival. Secondary outcomes included recurrence-free survival (RFS) and subsequent use of imaging tests, biopsy procedures, and salvage treatment. Median follow-up exceeded 8 years from prostate cancer diagnosis. Overall survival was not statistically significantly different across surveillance intensity groups among radiation therapy (P = .59) or radical prostatectomy (P = .29) patients. RFS was not statistically significantly different across surveillance intensity groups for radiation therapy (P = .13) patients but was for radical prostatectomy (P = .01) patients with high intensity associated with the worst RFS. In both treatments, higher surveillance intensity was associated with more procedures and salvage treatments. In patients with localized prostate cancer, more frequent PSA surveillance testing after radical prostatectomy or radiation therapy was associated with increased procedures and salvage treatments but not overall survival.

Urine protein to creatinine ratio remains informative despite non-steady state serum creatinine during AKI

IntroductionExperts have cautioned that assessment of proteinuria using urine protein to creatinine ratios (UPCRs) are not valid during acute kidney injury (AKI) since reduced urine creatinine in the denominator may artificially inflate the ratio. However, there is little empiric data assessing this theoretical concern. MethodsHere, we retrospectively examined changes in UPCRs measured during episodes of severe AKI and assessed whether the magnitude and direction of these changes associate with how the serum creatinine level is changing at the time of UPCR collection. We repeated these analyses comparing hospitalization UPCRs with pre/post hospitalization UPCRs where available. ResultsAmong 329 adults hospitalized with stage 2 or 3 AKI (defined as peak:nadir serum creatinine during hospitalization ≥2) at the University of California, San Francisco 1/1/2014 to 12/31/2021 with multiple UPCRs measured during AKI hospitalization, UPCR values were similar whether the serum creatinine was rising or falling at the time of measurement (median difference 0.06 g/g, IQR -0.26 to 0.50 g/g). There was no association between the difference in serum creatinine slopes when the UPCRs were collected and the difference in UPCR values (UPCR 0.05 g/g higher per mg/dL/day serum creatinine slope, 95% CI -0.36 to 0.47, p=0.80). UPCRs measured during hospitalization demonstrated positive and negative predictive values suggesting utility in appraising clinically relevant outpatient UPCR levels. ConclusionDespite non-steady state serum creatinine at the time of collection, UPCRs measured during AKI hospitalizations may be more informative than previously believed and should not be wholly disregarded.

Experiences of patients with endometriosis with a digital health application: a qualitative analysis

BackgroundEndometriosis is a frequent disease in women of reproductive age in which the endometrium occurs outside the uterine cavity. Multimodal treatment approaches are necessary due to loss of quality of life and the chronic nature of the disease. Digital health applications (DiGa) are becoming increasingly important. This research project investigates how a healthcare app can influence the subjective experience of illness in patients with endometriosis.MethodsEmpiric data were collected through semi-structured interviews. Data analysis was carried out using qualitative focussed interview analysis. Reliability was ensured by joint interdisciplinary and interprofessional evaluation of the interviews by experts and those affected.ResultsTen patients with endometriosis and the prescribed healthcare app Endo-App© were examined. Categories were defined from the superordinate categories “Factors influencing the experience of illness” and “Evaluation of the app”. The app provided reliable information, promoted self-efficacy through exercises and strengthened the perception of the individuality of the illness. It helped to minimise nocebo effects from internet research and enabled a positive change of perspective. Patients criticised the time required for data input and had data protection concerns. The educational elements were often seen as redundant. Some patients only used the app briefly, or not at all.ConclusionOnce a DiGa has been prescribed, it may be useful to explain its use on an outpatient basis and validate regular use. Blind re-prescribing of DiGas should be avoided. Younger patients with a recent diagnosis or patients following rehabilitation may benefit more from prescribing.

Optimizing colorectal cancer screening outreach: A probability-based strategy by Temple University Hospital.

e13502 Background: Temple University Hospital has created an initiative to increase colorectal cancer (CRC) screening to a historically underserved population in Northern Philadelphia through the administration of Fecal Immunochemical Tests (FIT). FIT testing possesses the advantage of being inexpensive and easy to use. Moreover, FIT testing serves as an additional opportunity for underserved patients to be integrated into a health network to receive lifesaving care when utilized by a large health system such as Temple Health. This study demonstrates how healthcare institutions, such as Temple Health, can employ probability-based modeling created from empiric data to navigate uncertainty and establish goals for the number of colonoscopies they aim to perform per a specific quantity of FIT tests distributed within the community. By doing so, they can significantly enhance the overall screening efforts in Northern Philadelphia and provide an essential service to those who need it most. Methods: FIT tests were distributed to the participants at community engagement events. FIT response rates, positivity rates, and progression to colonoscopy rates were determined and fit to a binomial distribution in Palisades @Risk software and underwent a Monte Carlo simulation of 10,000 iterations to determine the different probabilities of response rates, positivity rate, and colonoscopies performed per 1000 FIT tests distributed. Results: A total of 292 tests were distributed with a response rate of 56.5% (165 patients) and a positivity rate of 8.9% (26 patients). Out of 292 patients, 2.4% (7 patients) have had a colonoscopy or are scheduled to have a colonoscopy at Temple University Hospital. Probability curves were created to demonstrate the probability of number of responses, number of positive tests, and number of colonoscopies performed per 1000 FIT tests administered to the community. Lastly, we modeled the number of FIT tests that need to be administered to the community to perform at least 100 colonoscopies with different levels of certainty (Table). Conclusions: Here we show how hospital systems, like Temple Health, can use probability distributions based on empiric data to set tangible goals regarding their community engagement efforts to increase access to CRC screening. Through the utilization of probability distributions, healthcare organizations can gain deeper insights into resource allocation needs and strategically direct their initiatives, ultimately fostering a more inclusive and equitable approach to population-based CRC screening. [Table: see text]

Test characteristics for combining non-invasive liver fibrosis staging modalities in individuals with Hepatitis C virus.

Non-invasive methods have largely replaced biopsy to identify advanced fibrosis in hepatitis C virus (HCV). Guidelines vary regarding testing strategy to balance accuracy, costs and loss to follow-up. Although individual test characteristics are well-described, data comparing the accuracy of using two tests together are limited. We calculated combined test characteristics to determine the utility of combined strategies. This study synthesizes empirical data from fibrosis staging trials and the literature to estimate test characteristics for Fibrosis-4 (FIB4), APRI or a commercial serum panel (FibroSure®), followed by transient elastography (TE) or FibroSure®. We simulated two testing strategies: (1) second test only for those with intermediate first test results (staged approach), and (2) second test for all. We summarized empiric data with multinomial distributions and used this to estimate test characteristics of each strategy on a simulated population of 10,000 individuals with 4.2% cirrhosis prevalence. Negative predictive value (NPV) for cirrhosis from a single test ranged from 98.2% (95% CB 97.6-98.8%) for FIB-4 to 99.4% (95% CB 99.0-99.8%) for TE. Using a staged approach with TE second, sensitivity for cirrhosis rose to 93.3-96.9%, NPV to 99.7-99.8%, while PPV dropped to <32%. Using TE as a second test for all minimally changed estimated test characteristics compared with the staged approach. Combining two non-invasive fibrosis tests barely improves NPV and decreases or does not change PPV compared with a single test, challenging the utility of serial testing modalities. These calculated combined test characteristics can inform best methods to identify advanced fibrosis in various populations.

Defining ablative radiotherapy in patients with hepatocellular carcinoma: An expert consensus.

485 Background: External beam radiotherapy (EBRT) is a highly effective treatment in select patients with hepatocellular carcinoma (HCC). However, there are many types of EBRT described in the literature with no formal definition of what constitutes “ablative.” Thus, we convened a group of international experts to provide consensus on the parameters that define ablative EBRT in HCC. Methods: A Steering Committee was convened to generate a series of Key Criteria (KC) that could be used to define ablative EBRT for HCC. KC were based on factors related to dose, fractionation, radiobiology, target identification, and delivery technique. An international panel of experts participated in a modified Delphi (mDelphi) process to independently answer questions for each KC. Respondents were given 30 days to respond in round 1 of the mDelphi and 14 days to respond in round 2. A threshold of ≥ 70% was used to define consensus for answers to each KC. Results: Invitations were sent to 40 individuals and 35 (88%) returned responses. In the first round of the mDelphi, 3 of 7 KC reached consensus. In the second round, 100% of participants returned responses and consensus was reached in 3 of the remaining 4 KC. Based on this mDelphi analysis, there was expert agreement that ablative EBRT for HCC should be defined as 1) a BED10 ≥ 80 Gy, 2) daily imaging and multi-phasic contrast used for target delineation should be used, 3) treatment breaks (e.g., for adaptive EBRT) are allowed, but the total treatment time should be ≤ 6 weeks, 4) the equivalent dose when treating with protons should use a conversion factor of 1.1, and 5) there is no single conversion factor for carbon ions. In one KC, which questioned the expert’s opinion on the α/β ratio of HCC, consensus was not achieved. Conclusions: Using an mDelphi method assessing expert opinion, we provide the first consensus definition of ablative EBRT for HCC. Empiric data are required to define the α/β of HCC.

DEVELOPING FUNCTIONAL MULTILINGUALISM IN STUDENT AUDIENCES WITH BELARUSIAN MAJORITY: PRACTICAL PROPOSAL

The proposal contained in the title is linked to the development of multilingualism in student audiences with a Belarusian majority, regardless of the students’ main (first, native, etc.) language. The advantageousness of multilingualism in the educational process is a matter of wide consensus in the thematic literature. The idea of perceiving the entire linguistic repertoire of students as a valuable resource is developed based on approaches such as systemic functional linguistics, translanguaging and linguistic anthropology in education. The text considers the specifics of the application of these approaches in the Belarusian context. Multilingualism in Belarusian education is rather a declared condition than the real one, despite a high social need for it in society. The recommendations formulated in this paper deal with the main aspects of the organization of teaching aimed at the development of multilingual skills in Belarusian students. It is suggested that, in the first place, the practical level of language proficiency must be identified at university, since the school marks often fall short of indicating the actual ability to use the language. The proposals then elaborate on the formulation, together with students, of motivations for learning languages – and in particular, the Belarusian language. It is argued that young people often find such motivations beyond identitarian discourses of preserving the culture, history, or traditions, increasingly focusing instead on access to social capital, technology, mobility, artworks, and popular culture. The principle of multimodality in educational process is proposed, which can bring multilingualism into the new media dominated routine of young people. The capacity of the Belarusian language to serve for intercultural communication is discussed. It is argued that both the theory and empiric data should be multilingual to avoid hierarchical diglossia. Development of multilingualism among students also requires that teachers acquire and improve the necessary skills.

Benefits of Being Teamed with a Service Dog for Individuals Living with Visible and Invisible Disabilities.

Over 61 million people in the United States are living with disabilities. Less than one percent are teamed with service dogs. A service dog is a type of assistance dog specifically trained to perform a disability-related task(s) to assist the person and support their independence. Service dogs may also provide valuable secondary benefits. The aim of this survey research is to add empiric data on benefits of being teamed with a service dog. Two hundred and four individuals teamed with service dogs responded to demographic and survey questions that included the benefits they experience from being teamed with a service dog. Overwhelmingly, respondents agreed or strongly agreed to benefits of emotional connection (96%), community participation (97%), physical activity (96%), psychological wellbeing (98%), quality of life (97%), a reduction in prescribed medications (78%), and a decrease in paid or unpaid assistance hours (83%), which extend beyond their primary disability need. It is clear that many others may benefit from being teamed with a service dog. Greater evidence is needed to increase tangible support for those who desire to be teamed with a service dog and can meet the Americans with Disabilities requirements. Additionally, to support individuals with service dogs now and in the future, healthcare professionals need to be knowledgeable about and culturally competent in caring for patients teamed with service dogs. Service dogs, when indicated, may benefit individuals living with disabilities by meeting primary and secondary needs that support independence.

Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors.

Psychological and psychiatric care is a core domain of palliative care. Despite a high burden of mental health comorbidity among individuals with serious illness, the Accreditation Council of Graduate Medical Education gives little guidance about training hospice and palliative medicine (HPM) fellows in this domain of care. Currently, there is a lack of empiric data on HPM physician fellowship training in mental health topics. To characterize HPM physician fellowship training practices in the psychological and psychiatric aspects of palliative care. A cross-sectional survey study querying HPM fellowship training directors nationally. A total of 95 programs participated (51% response rate). A total of 98% programs offered didactics on mental health topics. Topics universally deemed as important by program directors were commonly taught, but there was variability in both the perceived importance and the didactic coverage of several topics. Only 15% of programs offered core rotations in psychiatry. Most programs offered psychiatry electives, but such electives were only rarely utilized by fellows. Interdisciplinary team (IDT) rounds infrequently included doctoral mental health clinicians. Beyond a few commonly identified and taught key topics, there is variability in clinical and didactic exposure to mental health training among HPM fellowships. Standardizing key learning objectives and guiding educators in how to achieve these objectives could improve the preparedness of the physician workforce in HPM to meet the mental health needs of patients with serious illness.

A-193 Effects of Delayed Centrifugation and Delayed Testing on the Stability of Comprehensive Metabolic Profile Analytes

Abstract Background The centralization of clinical laboratory testing has become increasingly common in recent years. While centralization allows for consolidation of resources, expanded test menus, procedural standardization, and improved efficiencies, central laboratories can face significant logistical challenges related to sample transport. In particular, problems may arise when samples are received from distant sites or if the courier services used to transport samples are infrequent or unreliable. Policies aimed to mitigate pre-analytical issues such as the time-to-centrifugation, the time-to-testing, and storage temperature, are best devised when driven by empiric data. Objective In this study, we provide stability studies for the Comprehensive Metabolic Panel (CMP) analytes in paired serum and lithium heparin (LiHep) plasma samples. Our findings not only complement preexisting literature data but also help guide the current sample acceptance criteria and policy for receiving satellite clinic samples in our laboratory. Methods Serum and LiHep plasma were collected from healthy volunteers in gel separator tubes. In one set of experiments, samples of both specimen types were all centrifuged within 30 min of collection and tested at pre-determined time intervals (2, 4, 6, 12, and 24 h post collection) using Roche Cobas 8000 system. In a second set of experiments, samples of both specimen types collected from another set of volunteers were kept at room temperature and only centrifuged prior to testing at pre-determined time intervals (2, 4, 6, 12, and 24 h post collection). Sample storage prior to testing was at room temperature. The percent recovery of each result was calculated relative to the first sample of the series. The CMP includes the following analytes: glucose, sodium, potassium, chloride, carbon dioxide, urea nitrogen, creatinine, calcium, total bilirubin, total protein, albumin, alkaline phosphatase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Results Glucose in promptly centrifuged (i.e., within 30 min of collection) LiHep plasma samples showed acceptable recovery (≥90%) when tested within 12 h of collection in LiHep gel separator tubes, whereas glucose stability in serum stored at room temperature exceeded 24 h. In contrast, delayed centrifugation beyond 3 h led to unacceptably low recoveries in both LiHep plasma and serum sample types. All other analytes included in the CMP were stable beyond 24 h irrespective of whether the sample type is LiHep plasma or serum, or even if the time-to-centrifugation was up to 24 h. Conclusions Based on the study, our laboratory has updated our policy to accept pre-centrifuged (i.e., within 30 min of collection) LiHep plasma from satellite clinics up to 8 h from blood collection, which is a 2-hour increase as compared to our prior cut-off acceptability. Given the location of our satellite clinics and unpredictability of sample transport, this increase represents a positive change in reducing outpatient sample rejections while ensuring reliable laboratory results.

Self-regulation, self-evaluation, and self-efficacy: How does its impact on employability?

&lt;span lang="EN-US"&gt;This study investigated whether self-regulation, self-evaluation, and self-efficacy can predict students’ employability levels, either simultaneously or partially. Researchers used class XII students of Muhammadiyah 1 Bambanglipuro Vocational High School, Indonesia with the criteria of having implemented industrial work practices (N=433) as research subjects. The sample consisted of 168 students obtained randomly by cluster sampling technique. Likert model scale as the main instrument in obtaining empiric data to answer the research hypothesis using multiple regression techniques with the help of the SPSS V.23 program. Based on the results of the analysis, it is known that self-regulation, self-evaluation, and self-efficacy have a very significant effect on the level of employability (F=134.28 and sig.=.000). Partially, each independent variable (self-regulation, self-evaluation, and self-efficacy) also has a very significant effect on employability with statistical values (t) obtained at 11.54, 3.24, 7.99 and sig. level of .000, .001, .000. These findings provide evidence that self-originating factors (self-regulation, self-evaluation, and self-efficacy) are sufficiently capable of increasing employability. Thus, it can be concluded that internal factors are one of the critical factors in predicting the employability of vocational students.&lt;/span&gt;

Correlation Between Students' Level of Anxiety and Their English-Speaking Skill

The purpose of this research is to find out empirical data about the correlation between students’ level of anxiety and their English speaking skill at the eight grade of MTs. Al-Kautsar Depok. This research used quantitative method through approach of correlation study. The research has taken empiric data especially the data of the students’ level of anxiety and their English speaking skill. The researcher had taken 190 students at the eight grade of MTs. Al-Kautsar Depok as the population. The sample of this research had taken from population consist of 24 students. The score of students’ level of anxiety was obtained from questionnaire that the researcher distributed, while the score of speaking skill was taken from the result of speaking test. The researcher used the Pearson Product Moment Test in hyphotesis testing and t-test to find out the correlations are significant or they only happen by chance. The result of this calculation found out that r=-0,656 while the t-test calculation found out tcount &gt; ttable (-4,081&gt;2,064). It means that Ho rejected. It shows that there is negative correlation between students’ level of anxiety and their English speaking skill. The determination coefficient is 43,1%. It means the students’ level of anxiety contributed 43,1% to the students’ speaking skill.Based on the statements above, it can be concluded that there is correlation between students’ level of anxiety and their English speaking skill at the eight grade of MTs. Al-Kautsar Depok.

State Regulation of Tourist Activity in View of In-Country Travel Development: Theory and Practice

The analysis of issues connected with state regulation of tourism is acute for the development of in-country travel, especially in previous years due to crises in society, economy and politics. The goal of the research is to characterize the relations of tourism with different spheres of life on the basis of the idea of tourism as a social and economic system and to work out indicators of its efficiency (social and economic). In the system of management in order to support the balance in state administrating and market relations indicators of social and economic efficiency were formulated, the authors pay special attention on social effectiveness and ecological stability. Examples of empiric data concerning state measures of supporting tourism today demonstrate the impact of economic and social factors. Results of estimating trends and regularities of in-country travel with regard to Russian conditions should be taken into account in forecasting and planning the field of tourism and in state regulation of tourism in developing policy in travel.

The association of a critical care electronic prescribing system with the quality of patient care provided by clinical pharmacists - a prospective, observational cohort study

BackgroundDespite the strong face validity of electronic prescribing (EP), the empiric data in support of improved patient safety is sparse. The objective of this study was to compare the clinical significance of pharmacist contributions between an established EP and paper-based prescribing (PBP) system in the intensive care unit (ICU) to understand the EP impact on the quality of patient care. Materials and MethodsWe conducted a prospective longitudinal study in two 18-bed ICUs; one with EP and the other, PBP. Pharmacist contributions were analysed over three months. Demographic, clinical and adjunctive intervention data were also collected. A multilevel ordinal logistic regression model was used and patients were followed up for 28 days. The primary outcome was the distribution of clinical significance levels of pharmacist contributions. ResultsThere were 303 patients admitted to the ICU between April 1st and June 30th 2018. EP was used in 171 patients and PBP in 132 patients. 1658 contributions were analysed. There were 14.9% highly clinically significant contributions with EP compared to 44.6% with PBP. The EP group had lower odds (OR 0.05, 95% CI 0.02–0.12) for a higher clinical significance contribution compared to the PBP group, but this changed over the admission and differed between groups, with decreasing odds of a higher-level clinical contribution for each additional admission day with PBP (OR 0.57, 95%CI 0.42–0.78). ConclusionThis study showed a significant difference in the distribution of pharmacist contributions made over time, with clinical significance levels remaining stable in the EP group at low severity, as opposed to PBP which were initially high and then gradually decreased in severity over time. This contemporaneous controlled study found that the EP system required less significant input both in the severity and frequency of pharmacist contributions to maintain patient safety.

COVID-19 epidemic modelling for policy decision support in Victoria, Australia 2020–2021

BackgroundPolicy responses to COVID-19 in Victoria, Australia over 2020–2021 have been supported by evidence generated through mathematical modelling. This study describes the design, key findings, and process for policy translation of a series of modelling studies conducted for the Victorian Department of Health COVID-19 response team during this period.MethodsAn agent-based model, Covasim, was used to simulate the impact of policy interventions on COVID-19 outbreaks and epidemic waves. The model was continually adapted to enable scenario analysis of settings or policies being considered at the time (e.g. elimination of community transmission versus disease control). Model scenarios were co-designed with government, to fill evidence gaps prior to key decisions.ResultsUnderstanding outbreak risk following incursions was critical to eliminating community COVID-19 transmission. Analyses showed risk depended on whether the first detected case was the index case, a primary contact of the index case, or a ‘mystery case’. There were benefits of early lockdown on first case detection and gradual easing of restrictions to minimise resurgence risk from undetected cases. As vaccination coverage increased and the focus shifted to controlling rather than eliminating community transmission, understanding health system demand was critical. Analyses showed that vaccines alone could not protect health systems and need to be complemented with other public health measures.ConclusionsModel evidence offered the greatest value when decisions needed to be made pre-emptively, or for questions that could not be answered with empiric data and data analysis alone. Co-designing scenarios with policy-makers ensured relevance and increased policy translation.

Choosing the Best Design in Surgical Research.

Choosing the Best Design in Surgical Research.

Rural age-friendly ecosystems for older adults: An international scoping review with recommendations to support age-friendly communities.

The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in urban areas. This scoping review seeks to (1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, (2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and (3) make person, practice, and policy-level recommendations to support active aging and development of age-friendly communities. An international scoping review was conducted of articles that used age-friendly framing, had a sample age of 45 years of age or older, self-identified as rural, and reported empiric data. Searches were conducted in PubMed, CINAHL, AgeLine, PsychINFO, EMBASE, Scopus, and Academic Search Elite on October 26, 2021, and rerun March 10, 2023. Data were charted across three analytic layers: socioecological model, Donabedian's framework, and SWOT analysis. Results reveal limited data on outcomes relevant to organizations, such as return on investment or healthcare utilization. While the SWOT analysis revealed many strengths of age-friendly systems, including their impact on persons' outcomes, it also revealed several weaknesses, threats, and gaps. Namely, age-friendly systems have weaknesses due to reliance on trained volunteers and staff, communication, and teamwork. System-level threats include community and health system barriers, and challenges in poor/developing areas. While age-friendly systems in this review were heterogeneous, there is an opportunity to focus on unifying elements including the World Health Organization age-friendly cities framework or 4Ms framework for age-friendly care. Despite the many benefits of age-friendly systems, we must acknowledge limitations of the evidence base, pursue opportunities to examine organizational metrics to support implementation and sustainability of age-friendly systems, and leverage improvements in age-friendliness at a community level.

Impact of protein-energy malnutrition on outcomes of patients with diffuse large B cell lymphoma admitted for inpatient chemotherapy

Background Protein-energy malnutrition (PEM) is a major factor contributing to morbidity and mortality in cancer patients. Empiric data are limited on the effect of PEM on the outcomes of patients receiving chemotherapy in diffuse large B cell lymphoma (DLBCL). Methods A retrospective cohort study was designed using data from the National Inpatient Sample for 2016 to 2019. Adult patients admitted for chemotherapy with DLBCL were stratified based on the presence of PEM. Primary outcomes assessed were mortality, length of stay, and total hospital charges. Results PEM was associated with an increased odds of mortality, 2.21% vs 0.25% (adjusted odds ratio 8.20, P < 0.001, 95% confidence interval [CI] 4.92–13.69). There was also an increased length of stay in patients with PEM, 7.89 vs 4.85 days (adjusted difference of 3.01 days, P < 0.001, 95% CI 2.37–3.66), as well as an increase in total charges, $137,940 vs $69,744 (adjusted difference of $65,427, P < 0.001, 95% CI $38,075–$92,778). Similarly, the presence of PEM was associated with increased odds of several secondary outcomes measured, including neutropenia, Candida sepsis, septic shock, acute respiratory failure, and acute kidney injury compared to the other cohort. Conclusion This study demonstrated an eightfold increased odds of mortality and concomitant prolonged length of stay with a 50% total charge increment in malnourished individuals with DLBCL compared to those without PEM. Prospective trials to evaluate PEM as an independent prognostic marker of chemotherapy tolerance and adequate nutritional support can improve clinical outcomes.